Botswana's Neighbors

Another interesting aspect of working in the public Botswana health system: who patients from neighboring countries are dealt with. We had the Zimbabwean Express while on call last night; 3 of the 11 patients admitted to our service were from Zimbabwe and thus are not covered by the state. As a result, we are even more severely limited as to what we can and cannot do. We can order labs, X-Rays, and so on, but the patient must pay for these out-of-pocket (which is understandably impossible for many of them). A guy came in last night: 34 year-old male complaining of weakness and tremors; he was febrile and very wasted. Our differential diagnosis at this point includes HIV, tuberculosis, or malignancy--and unfortunately I don't think we're going to be able to provide him with the care he needs regardless of the diagnosis--they won't be for his ARV's (anti-retrovirals) or ATT (anti-tuberculous therapy)...

Another interesting case: 25 year old man with known hemophilia B, which is pretty rare. Most patients with hemophilia (like the famous Romanov family in tsarist Russia) had hemophilia A, which is a deficiency in coagulation factor 8. He has hemophilia A, which is due to a deficiency in coagulation factor 9. First patient I've ever seen with this particular disorder. In any case, he has the rather unfortunate luck of having BOTH hemophilia B as well as a seizure disorder...which means that when he has a tonic-clonic seizure on the bus like what happened yesterday, he has trauma to his joints that results in massive bleeding into his joints. His right shoulder had barely no range of motion when he arrived and he was in a considerable amount of mine. The treatment for hemophilia B? Simple: just give them concentrated factor 9 (what their blood is lacking) to stop the bleeding. Unfortunately, our pharmacy had run out, and we had to wait until morning in order to get some (we did give him some fresh frozen plasma, which has a small amount of factor 9 in it, to get him through the night, and fortunately this morning he looks pretty good).

Well, it's a hot n' humid day, and I'm going to jump in the pool while it's still nice out. On tap for this weekend (I hope, if everything can be arranged): a camping trip to the Kalahari, which is famous for its high lion population!!